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Do not check orthostatic vital signs in patients with supine hypotension, shock, or severe alteration in mental status, or in those who may have spinal, pelvic, or lower-leg injuries.undefined#ref4">4
Medications that block a patient’s normal vasomotor and chronotropic response will interfere with fluid volume evaluation; however, to evaluate a patient’s reaction to a medication, obtaining orthostatic vital signs can be helpful.
Anticipate that the patient may experience dizziness and that an assistant may be necessary to help move the patient from a lying to a standing position. Do not leave the patient alone during this procedure.
Orthostatic vital signs are performed with the patient in different positions. The measurement of orthostatic vital signs is sometimes referred to as postural vital signs or the tilt test. This procedure is used for noninvasive evaluation of fluid loss from conditions such as vomiting, diarrhea, diaphoresis, bleeding, abdominal pain, and blunt abdominal or chest trauma. It can also be used to evaluate cerebral hypotension, unexplained syncope, weakness or dizziness, autonomic dysfunction, systemic hypotension, and response to a change in position in the older adult or ill patient.6 Orthostatic hypotension is impacted by increasing age, diagnosis of hypertension, multiple hypertensive medications, as well as polypharmacy.1
The value of orthostatic vital signs is disputed because there is no universal method on how to perform them or what blood pressure and heart rate changes constitute positive orthostatics. Orthostatic vital signs alone lack the sensitivity to detect volume losses of less than 1000 ml reliably.2 Therefore, the vital signs should be interpreted in the context of the patient’s other symptoms, such as dizziness, lightheadedness, fatigue, visual dimming, and shoulder pain.3 These symptoms can be aggravated by hot environments and in patients who tend to stand still without frequently changing position. Signs and symptoms of orthostatic changes are typically not present when the patient is supine but mostly materialize while standing and can be quickly resolved by sitting or lying down.3
Prevent unreliable results by avoiding invasive or painful procedures during the measurement of orthostatic vital signs.
Terminate the measurement if the patient becomes extremely dizzy and needs to lie down or experiences syncope.
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